Join BWC Please read the membership information carefully before submitting this application. Please fill out the application completely and press submit at the bottom to send it. You will be asked to sign your application at your first meeting. Or you can download a pdf that you can fill in on your computer and print to bring to a meeting. You can also request an application at your first visit. Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Website Service or product to be promoted through The Business Women's Connection:* (please describe in detail)Is your profession licensed by any organization?* Yes No If so, are you licensed?* Yes No N/A Other services or products which might overlap with yours, causing a conflict of exclusivity:Do you anticipate any difficulty with our attendance requirements?* No Yes (please explain below) Potential attendance difficultiesBusiness Address (if different from home address) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you belong to any other networking groups or leads clubs in which exclusive representation of product or service is a benefit of membership?* Yes No EmailThis field is for validation purposes and should be left unchanged.
